Contributor: Dhiren Patel, PharmD
Submitted by Quest Diagnostics
Many Americans struggle with chronic conditions. The CDC estimates six in 10 US adults have a chronic disease, and four in 10 have two or more. It is the leading cause of death and disability and a driver of the nation’s more than $3.8 trillion in annual healthcare costs. Four main risk factors have been identified for preventable chronic diseases: tobacco use, lack of physical activity, excessive alcohol use, and poor nutrition.[1,2]
Proper nutrition is extremely important in maintaining baseline health and reducing one’s risk for chronic disease. A healthful diet can help people diagnosed with chronic conditions manage their diseases and prevent complications. Unfortunately, food insecurity threatens an ever-increasing number of communities across the country. Food insecurity has become a leading nutrition issue, with 50 million Americans (over 14%) identifying as food insecure in 2013. Since then, that number has only grown, leading to a concerning amount of potentially negative health consequences stemming from poor nutrition.
Research shows that those with unhealthy diets may have a relatively greater number of chronic conditions. Given this data, a core intervention strategy across all evidence-based treatment plans to prevent chronic disease includes the promotion of healthy lifestyle behaviors, including improved diet. In addition, it is estimated that programs designed to help patients meet basic nutritional needs can translate to $200 per month in healthcare savings per patient.
Moreover, increasing access to nutrition is essential in helping patients overcome unmet needs and keeping individuals engaged in their healthcare. Oftentimes, patients with poorer nutrition are less engaged, and research shows that adults experiencing food insecurity are significantly more likely than their food-secure counterparts to delay or forgo medical care because of cost concerns. Studies have also shown that patients who are more engaged with their providers are more proactive, meaning they may be more likely to schedule check-ups, stay up to date on vaccines, and have testing done on schedule, likely leading to better health outcomes.
Given the obvious benefits of nutrition to health, should health plans incorporate nutritional and food access strategies into their services for members with chronic conditions? Based on our experience at Pack Health providing these services to health plans, the answer is yes, provided the strategy incorporates three key steps.
(1) Personalize Care
When members feel understood and supported by their health plan, we see much higher engagement. But patients who are food insecure are dealing with a host of issues, from mental health challenges to lack of access to technologies like telehealth. At Pack Health, we have learned that a one-size-fits-all approach does not work to improve food security and nutrition quality.
To that end, focusing on providing personalized services that meet patient needs is an important first step. As an example, some populations we work with require simple food delivery, while others need medically tailored meals with specific recipes. For some populations, directed spending cards are a better alternative. Yet one thing remains true across the board: Programs designed to address food insecurity have the potential to change lives, preventing as many as 3.28 million cardiovascular events, 620,000 deaths, and 120,000 cases of diabetes.
Additionally, since access to technology can be a barrier, our tools exist solely through the phone—any phone, with no app required—and include individually tailored support resources delivered via text and email to ensure personalization of care. We meet members where they are and start with a simple conversation to assess need without pressure.
(2) Education is a Prerequisite
Still, removing barriers like access is only a start. As an example, providing food through grocery delivery services does not address the root causes of poor nutrition, which, for some, may stem from an educational issue. But the good news is that, with a little creativity, it is possible to educate and spur behavioral changes leading to better health.
For instance, we recently produced a program for a major health plan that coupled grocery and meal delivery services with nutrition education through digital health coaching via weekly one-on-one calls, texts, and emails with our nutrition experts, generating an 86% overall program satisfaction rating.
(3) Set Up Channels to Listen and Engage
One thing the process of delivering food to the insecure has taught us, especially throughout the COVID-19 pandemic, is that the process must be collaborative. Listening to patients and their individual experiences is an elemental first step. Here, trust and connection are critical, as well as finding an experienced coaching provider capable of executing these three steps. When plans work with the right partners to deploy needed engagement options, screening tools, or data collection, processes can be put in place to get resources to insecure communities sooner.
Encouraging health plans to adopt patient engagement tools and tools that address critical components of health like nutrition is vital to curbing costs and promoting a healthier world overall. Nutrition and health are so closely intertwined and must be treated as a priority for decision-makers. Employers, health plans, and all those who consider the health of at-risk populations to be important should re-examine the ways they might attempt to get patients engaged in their healthcare. By improving access to food and other related services, better health can be achieved for these populations. All it takes is making the first step.
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 Willett WC, Koplan JP, Nugent R, et al. Prevention of Chronic Disease by Means of Diet and Lifestyle Changes. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2006. Chapter 44. Available from: https://ncbi.nlm.nih.gov/books/NBK11795/. Co-published by Oxford University Press, New York.
 Gundersen, C., & Ziliak, J. P. (2015). Food insecurity and health outcomes. Health Affairs, 34(11), 1830–1839. https://doi.org/10.1377/hlthaff.2015.0645
 Fanelli, S. M., Jonnalagadda, S. S., Pisegna, J. L., Kelly, O. J., Krok-Schoen, J. L., & Taylor, C. A. (2020). Poorer Diet Quality Observed Among US Adults With a Greater Number of Clinical Chronic Disease Risk Factors. Journal of primary care & community health, 11, 2150132720945898. https://doi.org/10.1177/2150132720945898
 Seth A. Berkowitz et al., “Meal delivery programs reduce the use of costly health care in dually eligible Medicare and Medicaid beneficiaries,” Health Affairs, April 2018, Volume 37, Number 4, healthaffairs.org.
 Jaclyn Bertoldo, Julia A. Wolfson, Samantha M. Sundermeir, Jeffrey Edwards, Dustin Gibson, Smisha Agarwal, and Alain Labrique, 2022: Food Insecurity and Delayed or Forgone Medical Care During the COVID-19 Pandemic. American Journal of Public Health 112, 776_785, https://doi.org/10.2105/AJPH.2022.306724
 Hibbard, J. H., & Greene, J. (2013). What the evidence shows about patient activation: Better health outcomes and care experiences; fewer data on costs. Health Affairs, 32(2), 207–214. https://doi.org/10.1377/hlthaff.2012.1061
 Lee, Y., Mozaffarian, D., Sy, S., Huang, Y., Liu, J., Wilde, P. E., Abrahams-Gessel, S., Jardim, T. de, Gaziano, T. A., & Micha, R. (2019). Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study. PLOS Medicine, 16(3). https://doi.org/10.1371/journal.pmed.1002761
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